Ginsberg Gary M, Geva Haim
Medical Technology Assessment Sector, Ministry of Health, Jermiahu 39, Jerusalem 9446724, Israel.
Department of Health Promotion, Ministry of Health, Jerusalem, Israel.
Isr J Health Policy Res. 2014 Aug 29;3:28. doi: 10.1186/2045-4015-3-28. eCollection 2014.
Tobacco use is the single most preventable cause of death, incurring huge resource costs in terms of treating morbidity and lost productivity. This paper estimates smoking attributable mortality (SAM) as health costs in 2014 in Israel.
Longitudinal data on prevalence of smokers and ex-smokers were combined with diagnostic and gender specific data on Relative Risks (RR) to gender and disease specific population attributable risks (PAR). PAR was then applied to mortality and hospitalization data from 2011, adjusted by population growth to 2014 to calculate SAM and hospitalization days (SAHD) caused by active smoking. These were used as a base for calculating deaths, hospital days and costs attributable to passive smoking, smoking by pregnant women, residential fires and productivity losses based on international literature.
The lagged model estimated active SAM in Israel in 2014 to be 7,025 deaths. Cardio-vascular causes accounted for 45.0% of SAM, malignant neoplasms (39.2%) and respiratory diseases (15.5%). Lung cancer alone accounted for 24.1% of SAM. There were an estimated 793, 17 and 12 deaths from passive smoking, mothers-to-be smoking and residential fires. Total SAM is around 7,847 deaths (95% CI 7,698-7,997) in 2014. We estimated 319,231 active SAHD days (95% CI 313,135-325,326). Respiratory care accounted for around one-half of active SAHD (50.5%). Cardio-Vascular causes for 33.5% and malignant neoplasms (13.2%). Lung cancer only for 4.6%. Total SAHD was around 356,601 days including 36,049 days from passive smoking. Estimated direct acute care costs of 356,601 days in a general hospital amount to around 849 (95% CI 832-865) million NIS ($244 million). Non acute care costs amount to an additional 830 million NIS ($238 million). The total health service costs amount to 1,678 million NIS (95% CI 1,646-1,710) or $482 million, 0.2% of GNP. Productivity losses account for a further 1,909 million NIS ($548 million), giving an overall smoking related cost of 3,587 million NIS (95% CI 3,519-3,656) or $1,030 million, 0.41% of GNP).
Smoking causes a considerable burden in Israel, both in terms of the expected 7,847 lives lost and the financial costs of around 3.6 million NIS ($1,030 million or 0.42% of GNP).
烟草使用是唯一最可预防的死亡原因，在治疗发病率和生产力损失方面产生了巨大的资源成本。本文估计了2014年以色列吸烟所致死亡率（SAM）作为健康成本。
将吸烟者和已戒烟者的纵向数据与相对风险（RR）的诊断和性别特异性数据以及疾病特异性人群归因风险（PAR）相结合。然后将PAR应用于2011年的死亡率和住院数据，并根据人口增长调整至2014年，以计算主动吸烟导致的SAM和住院天数（SAHD）。这些数据被用作计算被动吸烟、孕妇吸烟、住宅火灾和基于国际文献的生产力损失所致死亡、住院天数和成本的基础。
滞后模型估计2014年以色列的主动SAM为7025例死亡。心血管病因占SAM的45.0%，恶性肿瘤（39.2%）和呼吸系统疾病（15.5%）。仅肺癌就占SAM的24.1%。估计因被动吸烟、孕妇吸烟和住宅火灾导致的死亡分别为793例、17例和12例。2014年SAM总数约为7847例死亡（95%可信区间7698 - 7997）。我们估计主动SAHD天数为319231天（95%可信区间313135 - 325326）。呼吸护理约占主动SAHD的一半（50.5%）。心血管病因占33.5%，恶性肿瘤占13.2%。仅肺癌占4.6%。SAHD总数约为356601天，包括被动吸烟导致的36049天。综合医院356601天的估计直接急性护理成本约为8.49亿新谢克尔（95%可信区间8.32 - 8.65亿新谢克尔）（2.44亿美元）。非急性护理成本额外为8.3亿新谢克尔（2.38亿美元）。医疗服务总成本为16.78亿新谢克尔（95%可信区间16.46 - 17.10亿新谢克尔）或4.82亿美元，占国民生产总值的0.2%。生产力损失再增加19.09亿新谢克尔（5.48亿美元），使与吸烟相关的总成本达到35.87亿新谢克尔（95%可信区间35.19 - 36.56亿新谢克尔）或10.3亿美元，占国民生产总值的0.41%。
在以色列，吸烟造成了相当大的负担，无论是预期的7847人死亡，还是约3600万新谢克尔（10.3亿美元或国民生产总值的0.42%）的财务成本。
